basic cultural rifts: “Flemish” versus “French,” and “Catholic” versus “Free Thought” perspectives. Forty years later, in their systematic review of research on “detached concern,” Underman and Hirsfield (2016) identified a divergent trend: the recognition of empathy as an important component of medical education and ethical medical practice.
A manifestation of pragmatic acculturation in a healing system is the inclination of its practitioners to borrow ideas or procedures from other systems to solve specific problems without necessarily accepting the core values or premises of the system or systems from which they do the borrowing (Quah 2003). To illustrate: some traditional Chinese physicians use the stethoscope to listen to the patient’s breathing, or the sphygmomanometer to measure blood pressure, or the auto-clave to sterilize acupuncture needles, or a laser instrument instead of needles in acupuncture (Quah and Li 1989; Quah 1989a: 122–59). Norheim and Fonnebo (1998) illustrate the practice of pragmatic acculturation among young western biomedicine practitioners in Norway who learned and practiced acupuncture. Pragmatic acculturation has also facilitated the provision of western biomedical services to peoples from other cultures. Ledesma (1997) and Selzler (1996) studied the health values, health beliefs, and the health needs of Native Americans to improve the provision of relevant Western biomedical services to their communities. Adapting the type and mode of delivery of modern health care services to serve the needs of traditional peoples is receiving more serious attention from health care providers. Although pragmatic acculturation requires Western biomedicine practitioners to change or adapt their usual practices and assumptions, it is worthwhile if it attains the objective of making health care services more accessible to communities in need (e.g. Harmsen et al. 2008).
The presence and relative success of groups and institutions (for example, the medical profession, hospitals, and other health care organizations) involved in the provision of health care unfold in the context of culture. Arthur Kleinman (1980) highlights the relevance of the “social space” occupied by health systems. He identified significant differences among ethnic communities and the subsequent impact of cultural perceptions of mental illness upon the structure of mental health services. The influence of culture on the provision of mental health services is studied widely. Studying mental health in Vietnam, McKelvy and colleagues (1997: 117) found that “there is no profession specifically dedicated to hearing the woes of others. Talk therapy is quite alien to the Vietnamese”. Similarly, the traditional Vietnamese perception of child behavior and their “narrow” definition of mental illness help to explain their skepticism on the need for child psychiatric clinics.
Adding to social science research on the link between culture and health is the systematic discussion of culture within the realm of bioethics, including the nuances of informed consent, its meaning and interpretation among different ethnic groups (Turner 2005). Similarly, governments and health authorities recognize the importance of culture in illness prevention and the provision of healthcare services. One interesting example is the US Surgeon General’s Report on Mental Health (USDHHS 1999) and the supplement report on “Mental Health: Culture, Race and Ethnicity” (USDHHS 2001). The Supplement was intended as a collaborative document with social scientists and it became “a landmark in the dialogue – political and scientific – regarding health disparities in the United States” (Manson 2003: 395); and “more than a government document” as it discusses the significance of ethnicity in the planning and provision of preventive and curative mental health services (Lopez 2003: 420).
THE PERVASIVENESS OF CULTURE
In conclusion, culture has, does, and will continue to influence health-related behavior. There is a wealth of social science and, in particular, medical sociology research demonstrating the pervasiveness of cultural values and norms upon preventive health behavior, illness behavior, and sick-role behavior among individuals and groups as well as at the macro-level of healing systems.
The preceding discussion has highlighted three additional features of the study of culture in health and illness. The first of these features is the remarkable confluence of different and even opposite schools of thought in sociology concerning the need to analyze culture as an independent phenomenon, and the influence of culture upon agency and structure. The affective nature and subjectivity of one’s perceived identity as member of an ethnic group and the permeability of cultural boundaries are ideas found implicitly or explicitly in Durkheim, Weber, Parsons, as well as in Goffman, Foucault, and Habermas, among others. The second feature is the divergence of healing systems. Healing systems are not always internally consistent; different interpretations of the core values or principles of the system may be held by subgroups within the system. The third feature is pragmatic acculturation, that is, the borrowing from other cultures of elements, ways of thinking and ways of doing things, with the objective of solving specific or practical problems. This borrowing is very prevalent in matters of health and illness and is found in all types of health-related behavior. Finally, a comprehensive review of the relevant literature is not possible in this chapter given the enormous body of medical sociology research on health and culture. Instead, illustrations and the list of references are offered for each main argument in this discussion in the hope that the reader be enticed to pursue his or her own journey into this engaging research topic.
References
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